Which antibiotic works best for children with appendicitis?

In paediatric patients with appendicitis, the use of cefuroxime/metronidazole appears adequate for uncomplicated cases, while treatment with piperacilline/tazobactam may perform better for complicated cases, according to a study.

The authors conducted a retrospective cohort analysis involving 181 histologically confirmed paediatric patients with appendicitis. They then analysed symptoms, laboratory, imaging, microbiologic results, and management strategies.

A total of 139 microbiologic samples were obtained intraoperatively, supplying 226 isolates of 35 different microbiologic species. Escherichia coli (31 percent) was the most common pathogen, followed by members of the Streptococcus anginosus group (21 percent), Bacteroides fragilis (15 percent), and Pseudomonas aeruginosa (9 percent). 

The Pseudomonas and S. anginosus groups showed a significant association with perforation.

Notably, treatment resistance was prevalent among patients treated with ciprofloxacin (51 percent), followed by those who received cefuroxime/ceftriaxone (37 percent) and ampicillin/sulbactam (31 percent). On the other hand, low resistance rates were noted for cefuroxime/metronidazole (17 percent), piperacillin/tazobactam (8 percent), and meropenem (3 percent).

Resistance against cefuroxime/metronidazole was significantly associated with factors such as perforation, fever, and higher C-reactive protein values.

“Acute appendicitis is the most common cause for an acute abdomen worldwide, and laparoscopic appendectomy is the treatment of choice in most regions,” the authors said.

“Perioperative antibiotic therapy has shown to reduce postoperative complications. Conservative treatment strategies are under evaluation, especially in paediatric cohorts, but are not yet routinely used,” they added.